Active NPI
Dimitris N Tatakis, DDS, PHD
- Periodontics
- Columbus, OH
National Provider Identifier
1215288493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 00159
- Practice address
- 305 W 12TH Ave
Periodontology, College of Dentistry, Osu
Columbus, OH 43210-1267 - Phone
- (614) 292-0371
- NPI assigned
- Sep 27, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 48035 | CA | |
| Periodontics | 1223P0300X | 00159 | OH | Primary |
Addresses
Primary practice location
305 W 12TH Ave
Periodontology, College of Dentistry, Osu
Columbus, OH 43210-1267
Mailing address
305 W 12TH Ave
Periodontology, College of Dentistry, Osu
Columbus, OH 43210-1267
Phone (614) 292-0371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00159 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348704000000",
"number": "1215288493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"address_2": "PERIODONTOLOGY, COLLEGE OF DENTISTRY, OSU",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-0371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W 12TH AVE",
"address_2": "PERIODONTOLOGY, COLLEGE OF DENTISTRY, OSU",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101267",
"telephone_number": "614-292-0371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATAKIS",
"first_name": "DIMITRIS",
"middle_name": "N",
"credential": "DDS, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-27",
"last_updated": "2012-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "48035",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "00159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.